Provider Alert! Bivalent Pfizer COVID-19 Booster Vaccine Coverage Update

Date: October 12, 2022

Attention: All Providers

Effective Date: August 31, 2022

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.

Call to action: Texas Children’s Health Plan’s (TCHP) would like to notify providers that on August 31, 2022, the U.S. Food and Drug Administration (FDA) amended the Emergency Use Authorizations (EUAs) for the Pfizer-BioNTech COVID-19 vaccine to authorize a new, bivalent formulation designed to stimulate immunity to both the original strain of SARS-CoV-2 virus and the omicron variant.

• The new, bivalent Pfizer-BioNTech COVID-19 booster vaccine is authorized for individuals 12 years and older.
• The new vaccine formulation is not intended for use as either of the doses in the primary series.
• It should be administered as a single booster dose at least two months following completion of either a primary series of COVID-19 vaccines or monovalent booster vaccination.

How this impacts providers: TCHP wants providers to be aware that HHSC allows for pharmacy benefit coverage of the new, bivalent Pfizer-BioNTech COVID-19 booster vaccine in compliance with the EUA issued by the FDA.

Providers should educate eligible TCHP members about the health benefits of preventing COVID-19 infection and make TCHP members aware of increased access to this booster vaccine at a participating pharmacy.

Effective August 31, 2022, HHSC will cover the new, bivalent Pfizer-BioNTech COVID-19 booster vaccine National Drug Codes (NDCs) in the table below for Medicaid and CHIP as a payable pharmacy benefit:

Providers in MCO networks interested in enrolling as a COVID-19 vaccinator should visit www.dshs.texas.gov/coronavirus/immunize/provider-information.aspx for more information.

Next steps for providers: Providers should share this communication with their staff.

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers